Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France.
Ann Surg Oncol. 2010 Apr;17(4):1010-23. doi: 10.1245/s10434-009-0887-5. Epub 2010 Jan 6.
As the real clinical significance of carcinoembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA19.9) evolution during preoperative chemotherapy for colorectal liver metastases (CLM) is still unknown, we explored the correlation between biological and radiological response to chemotherapy, and their comparative impact on outcome after hepatectomy.
All patients resected for CLM at our hospital between 1990 and 2004 with the following eligibility criteria were included in the study: (1) preoperative chemotherapy, (2) complete resection of CLM, (3) no extrahepatic disease, and (4) elevated baseline tumor marker values. A 20% change of tumor marker levels while on chemotherapy was used to define biological response (decrease) or progression (increase). Correlation between biological and radiological response at computed tomography (CT) scan, and their impact on overall survival (OS) and progression-free survival (PFS) after hepatectomy were determined.
Among 119 of 695 consecutive patients resected for CLM who fulfilled the inclusion criteria, serial CEA and CA19.9 were available in 113 and 68 patients, respectively. Of patients with radiological response or stabilization, 94% had similar biological evolution for CEA and 91% for CA19.9. In patients with radiological progression, similar biological evolution was observed in 95% of cases for CEA and in 64% for CA19.9. On multivariate analysis, radiological response (but not biological evolution) independently predicted OS. However, progression of CA19.9, but not radiological response, was an independent predictor of PFS.
In patients with CLM and elevated tumor markers, biological response is as accurate as CT imaging to assess "clinical" response to chemotherapy. With regards to PFS, CA19.9 evolution has even better prognostic value than does radiological response. Assessment of tumor markers could be sufficient to evaluate chemotherapy response in a nonsurgical setting, limiting the need of repeat imaging.
由于癌胚抗原（CEA）和糖类抗原 19.9（CA19.9）在结直肠癌肝转移（CLM）术前化疗过程中的实际临床意义尚不清楚，我们探讨了化疗后生物和影像学反应之间的相关性，以及它们对肝切除术后结果的比较影响。
本研究纳入了 1990 年至 2004 年期间在我院接受 CLM 切除术且符合以下条件的所有患者：（1）术前化疗，（2）CLM 完全切除，（3）无肝外疾病，以及（4）肿瘤标志物基线值升高。使用肿瘤标志物水平在化疗期间变化 20%来定义生物学反应（下降）或进展（增加）。确定 CT 扫描的生物和影像学反应之间的相关性，以及它们对肝切除术后总生存期（OS）和无进展生存期（PFS）的影响。
在符合纳入标准的 695 例连续接受 CLM 切除术的患者中，有 113 例和 68 例患者分别有连续的 CEA 和 CA19.9 数据。在影像学有反应或稳定的患者中，CEA 和 CA19.9 的生物学演变相似的患者分别占 94%和 91%。在影像学进展的患者中，CEA 的生物学演变相似的患者占 95%，CA19.9 的生物学演变相似的患者占 64%。多变量分析显示，影像学反应（而非生物学演变）独立预测 OS。然而，CA19.9 的进展是 PFS 的独立预测因素，而不是影像学反应。
在有升高的肿瘤标志物的 CLM 患者中，生物反应与 CT 成像一样准确，可用于评估化疗的“临床”反应。就 PFS 而言，CA19.9 的演变比影像学反应具有更好的预后价值。在非手术环境下，评估肿瘤标志物可能足以评估化疗反应，从而减少重复成像的需要。
